Diagnosing BPD in Children

It is difficult to treat what is not diagnosed. Taya never received the treatment she needed, in part, because of the medical professionals who refused to consider a BPD diagnosis under the misguided and misinformed conviction that BPD cannot occur in children and adolescents.

This rejection of the BPD diagnosis runs counter to science. Experts such as Dr. Blaise Aguirre, MD, founding medical director of 3East continuum of care at McLean Hospital, state that BPD begins in childhood and adolescence.[1] Kiera Van Gelder[2], Stacy Pershall[3], Susanna Kaysen[4], and Rachel Reiland[5] wrote books about their experience with BPD; each describes the symptoms as beginning in childhood or adolescence.

The medical establishment has recently agreed that BPD can begin in adolescence. The latest version of the DSM (DSM-5) has a provision for diagnosis of BPD in people under 18 years old. Some clinicians have moved away from the DSM, relying instead on the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD). The ICD-10, the 10th edition of the ICD, became effective October 1, 2019. Its concise definition of BPD includes this, “Severe personality disorder that develops in early childhood; characterized by a lack of control of anger, intense and frequent mood changes, impulsive acts, disturbed interpersonal relationships, and life-threatening behaviors.”[6]

While the DSM-5 and the ICD-10 make it clear that BPD develops in early childhood, aside from the Green Mountain High School Interventionist Carla we did not find a single practitioner in our journey that followed that latest research. Rather, every other therapist, psychiatrist, and counselor espoused the outdated belief that BPD doesn’t occur in children and teens.

The National Institute of Health summarizes the issue this way, “Recognizable symptoms and features of BPD appear during adolescence. However, there has been resistance to diagnose or research this disorder prior to adulthood because of clinical lore that BPD is a long-standing illness and that personality traits are not stable until adulthood.”[7]

The challenge of finding competent, professional help for Taya was central to our story of losing her. How many therapists are still withholding the BPD diagnosis - and therefore the treatment - that young people need to survive? How many more beautiful children will die while we wait for the medical establishment to accept that BPD can emerge in childhood and metastasize long before the sufferer is old enough to obtain a driver’s license or vote?

[1] Aguirre, 201-202.

[2] Kiera Van Gelder, The Buddha and the Borderline, (New Harbinger Publications, Inc., 2010), prologue.

[3] Stacy Pershall, Loud in the House of Myself (W.W. Norton and Company, 2011), 6-25.

[4] Susanna Kaysen, Girl Interrupted (Vintage Books, 1993), 6-9.

[5] Rachel Reiland, Get Me Out of Here (Hazelden, 2004), 1-6.

[6] https://www.icd10data.com/ICD10CM/Codes/F01-F99/F60-F69/F60-/F60.3

[7] Stephanie D. Stepp, Development of Borderline Personality Disorder in Adolescence and Young Adulthood: Introduction to the Special Section